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Axenhus M, Mukka S, Magnéli M, Sköldenberg O. Comparative outcomes of uncemented and cemented stem revision in managing periprosthetic femoral fractures: a retrospective cohort study. J Orthop Traumatol 2024; 25:35. [PMID: 39023807 PMCID: PMC11258106 DOI: 10.1186/s10195-024-00777-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/30/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION Periprosthetic femoral fractures (PFFs) following hip arthroplasty, especially Vancouver B2 and B3 fractures, present a challenge due to the association with a loose femoral stem, necessitating either open reduction and internal fixation or stem revision. This study aims to compare outcomes between uncemented and cemented stem revisions in managing Vancouver B2 and B3 fractures, considering factors such as hip-related complications, reoperations, and clinical outcome. METHODS A retrospective cohort study was conducted at Danderyd Hospital, Sweden, from 2008 to 2022, encompassing operatively treated Vancouver B2 and B3 fractures. Patients were categorized into uncemented and cemented stem revision groups, with data collected on complications, revision surgeries, fracture healing times, and clinical outcomes. RESULTS A total of 241 patients were identified. Significant differences were observed between the two groups in patient demographics, with the cemented group comprising older patients and more females. Follow up ranged from 1 to 15 years. Average follow up time was 3.9 years for the cemented group and 5.5 years for the uncemented group. The cemented stems demonstrated lower rates of dislocation (8.9% versus 22.5%, P = 0.004) and stem loosening (0.6% versus 9.3%, P = 0.004) than the uncemented method. Moreover, the cemented group exhibited shorter fracture healing times (11.4 weeks versus 16.7 weeks, P = 0.034). There was no difference in clinical outcome between groups. Mortality was higher in the cemented group. CONCLUSIONS This retrospective study indicates that cemented stem revision for Vancouver B2-3 fractures is correlated with lower dislocation and stem loosening rates, necessitating fewer reoperations and shorter fracture healing times compared with the uncemented approach. The cemented group had a notably higher mortality rate, urging caution in its clinical interpretation. LEVEL OF EVIDENCE III
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Affiliation(s)
- Michael Axenhus
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden.
| | - Sebastian Mukka
- Department of Diagnostics and Intervention (Orthopaedics), Umeå University, Umeå, Sweden
| | - Martin Magnéli
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Division of Orthopaedics, Karolinska Institutet, Stockholm, Sweden
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Yang Y, Meng X, Huang Y. Study of the cement implantation syndrome: A review. Medicine (Baltimore) 2024; 103:e38624. [PMID: 38875363 PMCID: PMC11175870 DOI: 10.1097/md.0000000000038624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/08/2024] [Accepted: 05/28/2024] [Indexed: 06/16/2024] Open
Abstract
Bone cement implantation syndrome (BCIS) is a critical and potentially life-threatening condition that manifests during implantation. Characterized by a constellation of symptoms, including hypoxemia, hypotension, cardiac arrhythmias, elevated pulmonary vascular resistance, and occasionally cardiac arrest, BCIS typically ensues shortly after cement introduction, albeit with rare instances of delayed onset. Primarily attributed to the exothermic reaction of bone cement implantation, this syndrome is caused by local tissue damage, histamine and prostaglandin release, and microemboli formation, ultimately triggering a systemic immune response that culminates in respiratory and circulatory failure. The current hypotheses regarding BCIS include embolism, allergic reactions, and cement autotoxicity. BCIS management emphasizes preventative strategies, encompassing meticulous patient risk assessment, comprehensive preoperative and intraoperative evaluations, and precise cement application techniques. Treatment primarily involves symptomatic therapy and life-support measures to address the systemic effects of the syndrome.
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Affiliation(s)
- Yunze Yang
- Orthopedics and Traumatology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Xianyu Meng
- Orthopedics and Traumatology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Yiran Huang
- Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
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Lowe J, Winkel T. Argument for Noncemented Hemiarthroplasty in Geriatric Hip Fractures. J Orthop Trauma 2023; 37:e384-e386. [PMID: 37587569 DOI: 10.1097/bot.0000000000002648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Jason Lowe
- University of Arizona, College of Medicine, Tucson, AZ
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Chulsomlee K, Prukviwat S, Tuntiyatorn P, Vasaruchapong S, Kulachote N, Sirisreetreerux N, Tanphiriyakun T, Chanplakorn P, Sa-Ngasoongsong P. Correlation between shape-closed femoral stem design and bone cement implantation syndrome in osteoporotic elderly femoral neck fracture undergoing cemented hip arthroplasty: A retrospective case-control study in 128 patients. Orthop Traumatol Surg Res 2023; 109:103450. [PMID: 36273503 DOI: 10.1016/j.otsr.2022.103450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Bone cement implantation syndrome (BCIS) is a serious and potentially fatal complication especially in patients with osteoporotic femoral neck fracture (OFNF) undergoing cemented hip arthroplasty (CHA). Recent studies showed that the shape-closed femoral stem profile could lead to a significant increase of the intramedullary pressure during cementation and prosthesis insertion. This study aimed to (1) correlate the use of shaped-closed femoral stem and other perioperative risk factors with severe grade of BCIS grade 2 or 3: BCIS gr2/3, and (2) identify the prevalence of BCIS in the elderly patients with OFNF and treated with CHA. HYPOTHESIS Large wedge-shaped (or "shape-closed") femoral stem design would significantly associate with BCIS gr2/3 in the elderly patients who sustained OFNF and underwent CHA. PATIENTS AND METHODS A total of 128 OFNF patients, who aged over 75years and underwent CHA were retrospectively reviewed and then allocated into 2 groups: SC Group (use shape-closed femoral stem, n=40) and FC Group (use force-closed femoral stem, n=88). BCIS was grading in all patients according to Donaldson classification. Perioperative data between the patients with BCIS-gr2/3 and those with BCIS grade 0 or 1 (BCIS-gr0/1) were compared. Multiple logistic regression analysis was used to identify predictive factors for BCIS-gr2/3. RESULTS The prevalence of overall BCIS and BCIS-gr2/3 was 32.8% (n=42) and 6.2% (n=8), respectively. The total in-hospital and 1-year mortality rates were 2.3% and 4.7%, respectively. The major perioperative complication in patients with BCIS-gr2/3 was significantly higher compared to those in patients with BCIS-gr0/1 (62.5% vs. 10.0%, p=0.001). Multivariate analysis showed that age>90years (OR=9.4, 95% CI: 1.4-62.9, p=0.02), preinjury Parker mobility score<4 (OR=48.8; 95% CI: 2.7-897.2, p=0.008) and shape-closed femoral stem used (OR=19.1; 95% CI: 1.8-204.5, p=0.01) were the significant independent predictors for BCIS-gr2/3 in these patients. CONCLUSION BCIS in OFNF patients undergoing CHA is common and associates with a high major perioperative complication rate. Our initial hypothesis is validated as the patients at risk for BCIS-gr2/3 are those whose CHA procedures use a shape-closed femoral stem design and with extreme age, and having poor preinjury ambulatory status. Therefore, we recommended using cementless stem as the first option in OFNF. However, if CHA is needed, strict guideline for cement insertion should be followed with force-closed stem application to avoid the risk of BCIS-gr2/3. LEVEL OF EVIDENCE III; retrospective case-control study.
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Affiliation(s)
- Kulapat Chulsomlee
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasichol Prukviwat
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panithan Tuntiyatorn
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Satetha Vasaruchapong
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Noratep Kulachote
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Norachart Sirisreetreerux
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thiraphat Tanphiriyakun
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pongsthorn Chanplakorn
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Paphon Sa-Ngasoongsong
- Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Dahl OE, Pripp AH, Jaradeh M, Fareed J. The Bone Cement Hypercoagulation Syndrome: Pathophysiology, Mortality, and Prevention. Clin Appl Thromb Hemost 2023; 29:10760296231198036. [PMID: 37792504 PMCID: PMC10552457 DOI: 10.1177/10760296231198036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 10/06/2023] Open
Abstract
Since Charnley introduced acrylic cement to seal metallic hip prostheses in the 1950s, reports of perioperative fatal cardiorespiratory and vascular dysfunctions have been published. Studies on humans and animals have shown neurogenic stimulation and substantial local and systemic activation of coagulation are caused by surgical bone marrow damage and chemical cell destruction by toxic monomeric methyl methacrylate from the implanted cement and other tissue-released substances. Venous blood-borne cell fragments and conjugates of activated cells from the surgical site are sequestered and trapped in the pulmonary microcirculation. A substantial hypercoagulation occurs in the lung circulation. Hypercoagulable blood is passed over to the arterial side and may cause vessel obliteration and organ damage. This process may affect the brain, heart, and kidneys and, through the release of vasoactive substances, introduce hemodynamic imbalances that can lead to fatal outcomes in susceptible populations such as elderly patients with hip fractures. The main underlying pathophysiologic processes leading to these occasionally devastating outcomes are a substantial activation of coagulation and cell destruction caused by the toxic substance released by curing bone cement and several vasoactive substances.
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Affiliation(s)
- Ola E. Dahl
- Centre of Medical Science, Education, and Innovation, Innlandet Hospital Trust, Brumunddal, Norway
- Thrombosis Research Institute, London, UK
| | - Are Hugo Pripp
- Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Mark Jaradeh
- Department of Molecular Pharmacology & Neuroscience, Loyola University Medical Center, Maywood, IL, USA
| | - Jawed Fareed
- Department of Molecular Pharmacology & Neuroscience, Loyola University Medical Center, Maywood, IL, USA
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Maffulli N, Aicale R. Proximal Femoral Fractures in the Elderly: A Few Things to Know, and Some to Forget. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1314. [PMID: 36295475 PMCID: PMC9612001 DOI: 10.3390/medicina58101314] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022]
Abstract
Hip fractures are a leading cause of hospitalisation in elderly patients, representing an increasing socioeconomic problem arising from demographic changes, considering the increased number of elderly people in our countries. Adequate peri-operative treatment is essential to decrease mortality rates and avoid complications. Modern management should involve a coordinated multidisciplinary approach, early surgery, pain treatment, balanced fluid therapy, and prevention of delirium, to improve patients' functional and clinical outcomes. The operative treatment for intertrochanteric and subtrochanteric fractures is intramedullary nail or sliding/dynamic hip screw (DHS) on the basis of the morphology of the fracture. In the case of neck fractures, total hip replacement (THR) or hemiarthroplasty are recommended. However, several topics remain debated, such as the optimum thromboprophylaxis to reduce venous thromboembolism or the use of bone cement. Postoperatively, patients can benefit from early mobilisation and geriatric multidisciplinary care. However, during the COVID-19 pandemic, a prolonged time to operation with a subsequent increased complication rate have burdened frail and elderly patients with hip fractures. Future studies are needed with the aim to investigate better strategies to improve nutrition, postoperative mobility, to clarify the role of home-based rehabilitation, and to identify the ideal analgesic treatment and adequate tools in case of patients with cognitive impairment.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Centre for Sports and Exercise Medicine, Mile End Hospital, London E1 4DG, UK
- School of Pharmacology and Bioengineering, Guy Hilton Research Centre, Faculty of Medicine, Keele University, Thornburrow Drive, Hartshill, Stoke-on-Trent ST4 7QB, UK
| | - Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084 Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D’Aragona, 84131 Salerno, Italy
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Jordaan JD, Burger MC, Jakoet S, Manjra MA, Charilaou J. Mortality Rates in Femoral Neck Fractures Treated With Arthroplasty in South Africa. Geriatr Orthop Surg Rehabil 2022; 13:21514593221117309. [PMID: 35937556 PMCID: PMC9354128 DOI: 10.1177/21514593221117309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/29/2022] [Accepted: 07/12/2022] [Indexed: 11/15/2022] Open
Abstract
Objectives To investigate the mortality rate for neck of femur fractures treated with
arthroplasty at a tertiary level unit in South Africa and to evaluate the
effect of known risk factors for mortality in neck of femur fractures
treated with arthroplasty in the South African context. Design Retrospective cohort study. The main outcome was to determine mortality rates
during in hospital stay, at 3 months, 6 months 1 year post surgery. The
secondary outcome was to determine factors influencing mortality at 30 days,
6 months and 12 months post-surgery. Results Mortality rate was 3.3% in hospital, 5.6% at 30 days and 26.7% at 1 year. Age
>79, ASA score >3, and cementing of the femur had statistically
increased mortality risk (P < .001). Average length of
hospital stay was 12.3 ± 5.1 days (range 3.0-41.0 days) with 73% of patients
discharged back to pre-hospital home. Conclusion Mortality rates after femur neck fracture arthroplasty in South Africa are
slightly higher at 1 year compared to international data. However, the rates
are comparably low during hospital stay, 30 day and at 6 months
post-surgical intervals.
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Affiliation(s)
- Jacobus D Jordaan
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marilize C Burger
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Shafique Jakoet
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Muhammad Ahmed Manjra
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Johan Charilaou
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Dominguez ED, Kumar NN, Whitehouse MR, Sayers A. Mortality associated with cemented and uncemented fixation of hemiarthroplasty and total hip replacement in the surgical management of intracapsular hip fractures: A systematic review and meta-analysis. Injury 2022; 53:2605-2616. [PMID: 35595550 DOI: 10.1016/j.injury.2022.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of bone cement for implant fixation in the surgical management of intracapsular hip fractures (IHFs) remains controversial. Although UK national guidance supports cementation, many surgeons remain cautious of its use. In this systematic review and meta-analysis, we aimed to evaluate evidence surrounding post-operative mortality associated with cemented and uncemented total hip replacement and hemiarthroplasty implants. METHODS We conducted a search of MEDLINE and Embase databases for randomised controlled trials (RCTs) from commencement until 17 June 2020. Articles reporting mortality or patient survival as an outcome following total hip replacement (THR) or hemiarthroplasty (HA) to manage IHFs were included. Articles not comparing cemented and uncemented fixation were excluded. A meta-analysis on mortality stratified by post-operative follow-up period was conducted using a fixed-effects model. The Revised Cochrane risk-of-bias tool for randomized trials was used to assess risk of bias. RESULTS Our initial search found 77 references, 13 of which were eligible for full-text review. Mortality data from 12 studies were pooled and included in the meta-analysis. 1 599 operations were reported: 882 involved cemented fixation; 717, uncemented. Mortality outcome reporting ranged from less than 7 days to 5 years post-operation. No significant difference was observed between the two groups in mortality at any follow-up period. Study quality assessment revealed low certainty in mortality estimates. CONCLUSION Existing evidence indicates that cementation has no effect on mortality at any reported follow-up time period. Even with the use of evidence synthesis, the sample size remains relatively low for mortality outcomes and insufficiently powered to reliably determine differences between groups.
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Affiliation(s)
- Elizabeth D Dominguez
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
| | - Nakulan N Kumar
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, University of Bristol, Bristol, United Kingdom
| | - Adrian Sayers
- Musculoskeletal Research Unit, Translation Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Panghate A, Jogani AD, Panchal S, Desai J, Marathe N, Rathod R. An evaluation of peri-operative clinical, serological and radiological parameters in hip arthroplasties -a prospective observational study of Indian cohorts. J Orthop 2022; 30:98-102. [PMID: 35250197 PMCID: PMC8889370 DOI: 10.1016/j.jor.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The scarcity of mortality data in our country led to systematic effort with aim of evaluating peri-operative parameters associated with mortality in hip arthroplasties to determine better fixation method and reducing avoidable variables. MATERIALS & METHODS 252 consecutive patients (133 males and 119 females; Mean age 58.68 years) operated for hip arthroplasties (cemented & uncemented THR and bipolar hemiarthroplasty) were observed prospectively for 2 years. Heart-rate, O2 saturation and BP were recorded at specific surgical steps and post-operatively for 48 h. Post-operative Trop-T and 2D Echocardiography were done in all patients and D-Dimer and CTPA in indicated ones. All post-operative deaths were extensively studied. RESULTS - Majority (63%) were operated for traumatic indications.48% belonged to ASA grade-1, 46% grade-2 and 4% grade-3. There was statistically significant association of diagnosis (traumatic aetiology), ASA grade 2, raised Troponin -T, raised D-dimer and pulmonary embolism with mortality. Mortality rate in our study at post-op 48 h was 5.5%, 30 day- 8% and 1-year mortality rate was 19%. With total of 14 deaths, 8 deaths (57.14%) occurred among 127 cemented arthroplasties and 6 deaths (42.86%) among 125 uncemented arthroplasties. CONCLUSIONS Selection of implant (cemented or uncemented) made no difference in eventual mortality. Collaborative effort of orthopaedic surgeon, anaesthetist and experts from respective fields in elderly high-risk patient with vigilant post-operative surveillance for minimum 48 h would help in lowering mortality associated with hip arthroplasties.
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Affiliation(s)
- Atul Panghate
- Seth GS Medical College & KEM Hospital, Mumbai, 400012, India
| | | | - Sameer Panchal
- Dept of Orthopaedics, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, 400008, India,Corresponding author. Dept of Orthopaedics, Grant medical College and Sir JJ group of hospitals, Mumbai, 400008, India.
| | - Jigar Desai
- Seth GS Medical College & KEM Hospital, Mumbai, 400012, India
| | | | - Rajkumar Rathod
- Lilavati Hospital and Research Centre, Bandra West, Mumbai, 400050, India
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Valiton V, Giannakopoulos G, Müller H. Catastrophic Bone Cement Implantation Syndrome Treated with Venoarterial Extracorporeal Membrane Oxygenation: A Case Report. CASE 2022; 6:24-26. [PMID: 35243196 PMCID: PMC8883139 DOI: 10.1016/j.case.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BCIS is a rare but serious complication of cemented bone surgeries. The pathophysiology is suggested to be a pulmonary embolization of various particles. Cardiopulmonary conditions, femur fracture, and old age are risk factors of BCIS. Percutaneous VA ECMO may provide transient support for acute hemodynamic instability.
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Dahl OE, Pripp AH. Does the Risk of Death Within 48 Hours of Hip Hemiarthroplasty Differ Between Patients Treated with Cemented and Cementless Implants? A Meta-analysis of Large, National Registries. Clin Orthop Relat Res 2022; 480:343-350. [PMID: 34491939 PMCID: PMC8747483 DOI: 10.1097/corr.0000000000001952] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although current recommendations suggest that hip hemiarthroplasties performed for femoral neck fractures be implanted with bone cement, it is known to cause cardiorespiratory and hemodynamic reactions that in some patients can be fatal. Older patients may be at particular risk of this complication, but because of its relative infrequency, large studies-perhaps even larger than can be achieved in the context of single-country national registries-are needed to get reasonably precise estimates as to its frequency. Pooling results from national registries reporting on death within 48 hours of cement exposure in this setting may therefore be helpful. QUESTION/PURPOSE In a systematic review of studies based on large national registries, we asked: Does the risk of death within 48 hours of hip hemiarthroplasty differ between patients treated with cemented and cementless implants? METHODS MEDLINE and Embase data sources were searched for cohort studies on patients with hip fractures treated with cement or cementless hip hemiprostheses based on results from national registries that tracked perioperative deaths within 48 hours of surgery, from 2010 or later (to include only studies that used contemporary cement techniques). We excluded registry research on elective THAs for other indications (such as degenerative joint disease), mixed populations (registries that combined patients having arthroplasty for fracture and for other diagnoses like osteoarthritis, such that we could not separate them), and overlapping data from the same registers (to avoid double and triple publications of similar data). Five studies met our inclusion criteria. The cohorts ranged from about 11,000 to about 25,000 patients. About 31% of the patients were in the cementless group. Two studies reported the age ranges of participating patients, and three studies communicated mean ages (which were 82 years for both sexes). Twice as many females as males were present in both the cemented and cementless group. When reported, more than 50% in both groups were in the American Society of Anesthesiologists physical status classification 3 or 4. Study quality was deemed good according to the Newcastle-Ottawa Scale. Publication bias was assessed using a funnel plot and the Egger test, and study heterogeneity was evaluated using the I2 heterogeneity statistic and Cochran Q heterogeneity test. There was some heterogeneity between the studies, with a Cochran Q statistics of 8.13 (degrees of freedom = 4; p = 0.08) and an I2 statistic of 50.8%. There was evidence for a small amount of publication bias (Egger test; p = 0.02). The pooled risk ratio (RR) from a random-effects model is presented with 95% confidence intervals. The primary endpoint was the occurrence of any fatalities within 48 hours of hip fracture treatment with cementless compared with cemented prostheses. We performed a sensitivity analysis to assess the needed association of a potential unmeasured or uncontrolled confounding, and we made an estimate of the amount of unmeasured confounding that would need to be present in order to change the direction of the result. We summarized this using a parameter known as the "E-value." Based on that sensitivity analysis, we found it unlikely that an unmeasured hypothetical confounder could explain the significant association between cemented and cementless implants and risk of death within 48 hours of hip hemiarthroplasty. RESULTS Compared with the cementless group, mortality was increased in the cemented group (RR 1.63 [95% CI 1.31 to 2.02]; p < 0.001). The number needed to harm from the pooled data was 1 of 183 operated patients; that is, for every 183 patients treated with cemented implants, one death would be expected. CONCLUSION Bone cement is associated with a higher risk of fatalities within 48 hours of surgery compared with cementless prostheses. However, numerous prior studies have found a higher risk of serious complications resulting in additional surgical procedures associated with cementless devices in this population; those complications, as well, may result in death. Based on our study alone, we cannot recommend cementless implants in this setting. Large, national registries should evaluate fixation choice in older patients with hip fractures, and those studies should consider both early death and the potential for later harms. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Ola E. Dahl
- Centre of Medical Science, Education and Innovation, Innlandet Hospital Trust, Brumunddal, Norway
- Thrombosis Research Institute, London, UK
| | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, Oslo, Norway
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12
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Cemented and uncemented hemiarthroplasty for femoral neck fracture in elderly patients: a systematic review and meta-analysis. Aging Clin Exp Res 2021; 33:2087-2111. [PMID: 33068266 DOI: 10.1007/s40520-020-01731-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/30/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cemented hemiarthroplasty to treat femoral neck fractures (FNFs) in elderly patients is controversial. Therefore, this study aimed to compare cemented vs uncemented outcomes. METHODS A literature review using Pubmed, EMBASE, Cochrane Library, and Science Citation Index databases was conducted. Studies comparing outcomes of cemented with uncemented hemiarthroplasty for FNFs in elderly patients up to March 2020 were included. Dichotomous outcomes were pooled and reported as relative risk (RR) or odds ratio (ORs), while continuous outcomes were pooled and reported as the mean difference (MD) or standardized mean difference (SMD). RESULTS The analysis included 39 studies with a total of 112 576 patients. Pooled analysis revealed that compared with cemented, patients with uncemented intervention had better outcomes for intraoperative blood loss (OR 0.19; 95% CI 0.01-0.37), systolic blood pressure (OR 2.83; 95% CI 1.51-5.28), surgery duration (SMD, 0.51; 95% CI 0.2-0.81), length of anesthesia (OR 0.28; 95% CI 0.11-0.45), 6-month mortality (OR 1.11; 95% CI 1.03-1.2), cardiovascular accidents (OR 2.14; 95% CI 1.07-4.28), respiratory failure (OR 8.26; 95% CI 1.38-49.4), fat embolisms (OR 1.58; 95% CI 1.29-1.93), and heterotrophic ossification (OR 2.3; 95% CI 1.3-4.06), but more intraoperative accidents (OR 0.34; 95% CI 0.26-0.45), postoperative fractures (OR 0.27; 95% CI 0.21-0.34), reoperations (OR 0.59; 95% CI 0.53-0.65), and revisions (OR 0.62; 95% CI 0.44-0.88). CONCLUSIONS Meta-analysis of hemiarthroplasty outcomes shows that elderly patients who underwent uncemented vs cemented procedures had better results for several factors that are important for not only improved recovery in elderly populations, but also more intraoperative and postoperative risks.
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Murphy EP, Fenelon C, Cassar-Gheiti A, O'Loughlin P, Curtin W, Murphy CG. Does Proximal Femoral Morphology Impact Morbidity and Mortality? A Cohort Study of Uncemented Hemiarthroplasties in the Treatment of Femoral Neck Fractures. Arthroplast Today 2021; 10:57-62. [PMID: 34307812 PMCID: PMC8283011 DOI: 10.1016/j.artd.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background To assess outcomes after uncemented hemiarthroplasty stems in the treatment of intracapsular femoral neck fractures over an 11-year period. Mortality rates were assessed, and whether proximal femoral geometry and stem alignment were factors in intraoperative or postoperative periprosthetic fracture (PPF) needs to be identified. Materials and Methods A retrospective single-center observational study was conducted of all patients who underwent intracapsular femoral neck fracture treatment using an uncemented prosthesis between January 2008 and December 2018. Primary endpoints included mortality rate, Dorr classification, prosthesis alignment, intraoperative fracture, and reoperation rate for any reason. Subanalysis on collared and uncollared implants was also conducted. Multivariate logistic regression was performed based on Dorr classification for stem alignment, fracture incidence, reoperation rate, implant sizing, and patient mortality. Results A total of 536 patients received an uncemented hemiarthroplasty in the study period. The mean patients age was 80.4 years, of which 71% were female. The 30-day mortality rate was 5.2%, with no deaths on day zero or day one. Twenty patients (3.7%) sustained an intraoperative calcar fracture, and 14 patients a PPF (2.6%) at a mean of 1.3 years from surgery. Dorr C type femurs were more likely to develop a PPF (P = .001), while valgus stem alignment was associated with PPF (P = .049). Conclusions This implant has low reoperation rates, low early postoperative mortality, and low 30-day mortality. This large single-center study provides up-to-date information using a contemporary stem in patients with multiple comorbidities. Dorr C femoral morphology and valgus stem malalignment were risk factors for postoperative fractures.
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Affiliation(s)
- Evelyn P Murphy
- Department of Trauma and Orthopaedics, Galway University Hospitals, Saolta Hospital Group, Galway, Ireland
| | - Christopher Fenelon
- Department of Science and Engineering, University of Limerick, Limerick, Co, Limerick, Ireland
| | - Adrian Cassar-Gheiti
- Department of Trauma and Orthopaedics, Galway University Hospitals, Saolta Hospital Group, Galway, Ireland
| | | | - William Curtin
- Department of Trauma and Orthopaedics, Galway University Hospitals, Saolta Hospital Group, Galway, Ireland
| | - Colin G Murphy
- Department of Trauma and Orthopaedics, Galway University Hospitals, Saolta Hospital Group, Galway, Ireland
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Parker MJ, Johansen A, Griffiths R. Bone cement and hip fractures. Injury 2021; 52:1655-1656. [PMID: 34030862 DOI: 10.1016/j.injury.2021.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/04/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Martyn J Parker
- Peterborough and Stamford Hospital NHS Foundation Trust, Department of Orthopaedics, Peterborough City Hospital, CBU PO Box 211, Bretton Gate, Peterborough, PE3 9GZ, UK.
| | - Antony Johansen
- University Hospital of Wales, Cardiff, CF14 4XW, UK; National Hip Fracture Database (NHFD), Royal College of Physicians, London, UK.
| | - Richard Griffiths
- Peterborough and Stamford Hospital NHS Foundation Trust, Peterborough City Hospital, UK.
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Schuetze K, Ehinger S, Eickhoff A, Dehner C, Gebhard F, Richter PH. Cement augmentation of the proximal femur nail antirotation: is it safe? Arch Orthop Trauma Surg 2021; 141:803-811. [PMID: 32710347 DOI: 10.1007/s00402-020-03531-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cement augmentation of the proximal femur nail antirotation (PFNA; Fa. DePuy Synthes) showed good biomechanical and clinical results regarding increased stability and functional outcome [Linden et al. in J Orthop Res 24:2230-2237, 2006;Kammerlander et al. in Injury 49:1436-1444, 2018;]. Cement-associated complications are well known in orthopedic procedures like hip arthroplasty, vertebra- and kyphoplasty. This study investigates outcome and safety of augmentation of the proximal femur nail blade. MATERIALS AND METHODS The retrospective review of the 299 patients (mean age 80 ± 13 years; 205 women and 94 men) focused on perioperative complications after augmentation which was performed with Traumacem V+ Cement (Fa. DePuy Synthes) in 152 cases. The decision for augmentation of the blade was made by the attending surgeon and based on the factors age, bone quality, and fracture pattern. Primary outcome measures were changes in blood pressure, heart rate or oxygen saturation, and the number of needed vasoactive drugs during augmentation. Secondary outcome measures where the rate of cement leakage into the joint, mechanical failure, and perioperative complications like pulmonary embolism, stroke, or heart attack. RESULTS In 152 augmented cases, no leakage of cement into the joint could be detected. No signs of mechanical failure like cut-out of the blade were seen after 6 weeks and 3 months. Also, augmentation did not show a higher rate of mortality or postoperative complications like stroke, heart attack, embolism, or infection. 57 of 152 augmented cases received an intraoperative intervention with vasoactive medication at the time of augmentation either prophylactically or because of a blood pressure fall. Out of the non-augmented cases, 21 of 147 needed vasoactive medication in the second half of the operation. The difference between these groups was significant (p < 0.05). In the cases without an intervention, there was a significant blood pressure fall of about 8 ± 7.4 mmHg during the augmentation (p < 0.001). Still, none of the augmented cases showed a change in heart rate or oxygen saturation. CONCLUSION The augmentation of the PFNA blade proved to be a safe procedure. Cement augmentation will not increase postoperative complications or mortality. The risk for leakage of cement into the joint is low and mechanical cut-out might be prevented. The decision for augmentation should be made carefully and always be declared loud and in advance to allow the anesthetist to prepare, because blood pressure changes can occur.
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Affiliation(s)
- Konrad Schuetze
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - S Ehinger
- Department of Anesthesiology, University Hospital Ulm, Ulm, Germany
| | - A Eickhoff
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - C Dehner
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - F Gebhard
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - P H Richter
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Maydanshahi MR, Kachooei AR, Eygendaal D, Ebrahimzadeh MH, Nazarian A, Mousavi Shaegh SA. 3D printing-assisted fabrication of patient-specific antibacterial radial head prosthesis with high periprosthetic bone preservation. Biomed Mater 2021; 16. [PMID: 33524959 DOI: 10.1088/1748-605x/abe217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/01/2021] [Indexed: 11/12/2022]
Abstract
We present a novel fabrication and surgical approach for anatomical reconstruction of a fractured radial head using patient-specific radial head prosthesis made of polymethylmethacrylate (PMMA) bone cement. To this end, the use of PMMA bone cement for prosthesis fabrication was initially investigated using computational modeling and experimental methods. The radial head prosthesis was fabricated through casting of PMMA bone cement in silicone mold in the operation room before implantation. To enhance the precision of bony preparation for replacement of the radial head, patient-specific surgical guide for accurate resection of the radial neck with the desired length was developed. Post-surgical clinical examinations revealed biomechanical restoration of elbow function, owing to the use of patient-specific radial head prosthesis and surgical guide. Importantly, follow-up radiographs after a mean follow-up of 18 months revealed bone preservation at the bone-prosthesis interface without any signs of erosion of the capitellum. Taken together, our method demonstrated the safety and efficacy of the PMMA radial head prosthesis in restoring elbow biomechanics. This also provides a very safe and cost-effective method for making various patient-specific prostheses with localized antibacterial delivery and close mechanical properties to native bone for improved periprosthetic bone regeneration.
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Affiliation(s)
- Mohammad Reza Maydanshahi
- Orthopaedic Research Center, Mashhad University of Medical Sciences, Orthopedic research center, Ghaem hospital, Mashhad University of Medical Sciences,Ahmadabad street, Mashhad, Mashhad, Razavi Khorasan, 00000, Iran (the Islamic Republic of)
| | - Amir Reza Kachooei
- Orthopaedic Research Center, Mashhad University of Medical Sciences, Orthopedic research center, Ghaem hospital, Mashhad University of Medical Sciences, Ahmadabad street, Mashhad, Mashhad, Razavi Khorasan, 00000, Iran (the Islamic Republic of)
| | - Denise Eygendaal
- Amsterdam University Medical Centers, Department of Orthopaedic Surgery, University of Amsterdam, University of Amsterdam, Amsterdam University Medical Centers, Department of Orthopaedic Surgery Amsterdam, Noord-Holland, Amsterdam, Noord-Holland, 1100 DD , NETHERLANDS
| | - Mohammad Hossein Ebrahimzadeh
- Orthopaedic Research Center, Mashhad University of Medical Sciences, Orthopedic research center, Ghaem hospital, Mashhad University of Medical Sciences,Ahmadabad street, Mashhad, Mashhad, Razavi Khorasan, 00000, Iran (the Islamic Republic of)
| | - Ara Nazarian
- Beth Israel Deaconess Medical Center, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA, Boston, Massachusetts, 02215, UNITED STATES
| | - Seyed Ali Mousavi Shaegh
- Mashhad University of Medical Sciences, Clinical Research Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, 00000, Iran (the Islamic Republic of)
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Fenelon C, Murphy EP, Pomeroy E, Murphy RP, Curtin W, Murphy CG. Perioperative Mortality After Cemented or Uncemented Hemiarthroplasty for Displaced Femoral Neck Fractures-A Systematic Review and Meta-analysis. J Arthroplasty 2021; 36:777-787.e1. [PMID: 32943317 DOI: 10.1016/j.arth.2020.08.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/24/2020] [Accepted: 08/21/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Debate surrounds the use of cemented or uncemented prostheses for the treatment of displaced femoral neck fractures (FNF). Many guidelines recommend the use of the cemented hemiarthroplasty (CHA). Proponents of CHA point out the increased re-operation rate while proponents of uncemented hemiarthroplasty (HA) highlight the increased mortality rate in the perioperative period. The aim of this study was to systematically review the literature to evaluate perioperative mortality after HA for displaced FNFs. METHODS A systematic review and meta-analysis was performed of MEDLINE, Cochrane Library, and Embase databases evaluating perioperative mortality after HA for displaced FNFs. Randomized control trials and observational studies were included comparing current-generation stem designs. A meta-analysis was performed on studies that directly compared the different modes of fixation. RESULTS Twenty-two studies were included (seven randomized control trials and 15 observational studies), with a total of 183,167 HAs for treatment of a displaced FNF. Fourteen studies were included in the meta-analysis. There was a higher cumulative odds of death within the first 48 hours in those with CHA compared with uncemented HA (OR: 1.64; 95% CI: 1.35, 2.00; P ≤ .01). No difference was found in mortality at 7 days, 30 days, and one year. CONCLUSION CHA is associated with an increased mortality rate within the first two days of surgery with no difference at 7 days, 30 days, and one year. Surgeons should consider tailoring their stem choice based on the physiological status of the patient when planning HA for FNFs. Techniques to reduce the risk of bone cement implantation syndrome should be used.
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Affiliation(s)
- Christopher Fenelon
- Department of Orthopaedic Surgery, National Orthopaedic Hospital Cappagh, Dublin, Ireland
| | - Evelyn P Murphy
- Department of Orthopaedic Surgery, National Orthopaedic Hospital Cappagh, Dublin, Ireland
| | - Eoghan Pomeroy
- Department of Orthopaedic Surgery, National Orthopaedic Hospital Cappagh, Dublin, Ireland
| | - Robert P Murphy
- Department of Orthogeriatric Medicine, Galway University Hospital, Galway, Ireland
| | - William Curtin
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
| | - Colin G Murphy
- Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland
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Yang TH, Yang RS, Lin CP, Tseng TH. Bone Cement Implantation Syndrome in Bone Tumor Surgeries: Incidence, Risk Factors, and Clinical Experience. Orthop Surg 2020; 13:109-115. [PMID: 33274603 PMCID: PMC7862161 DOI: 10.1111/os.12842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/07/2020] [Accepted: 09/28/2020] [Indexed: 01/18/2023] Open
Abstract
Objective To investigate the incidence and risk factors of bone cement implantation syndrome (BCIS) in bone tumor surgeries. Methods This was a retrospective observational study. We investigated patients who underwent bone tumor surgeries requiring cementation as part of the surgery between March 2016 and January 2018. We reviewed medical records, including formal anesthesia records and operation notes. Patients with complete data files were included. To investigate the general incidence of BCIS in tumor surgeries, patients of all ages, genders and tumor types were included. Vital signs, including oxygen saturation, blood pressure, heart rate, and respiratory rate, were checked and recorded once every 1–2 min after cementation. Accurate time points of cementation were recorded on formal anesthesia record sheets by the anesthesiologists. The definition and severity of BCIS were based on the classification system proposed in previous studies: grade I, moderate hypoxia (SpO2 <94%) or hypotension (fall in systolic blood pressure >20%); grade II, severe hypoxia (SpO2 <88%) or hypotension (fall in systolic blood pressure >40%) or unexpected loss of consciousness; and grade III, cardiovascular collapse requiring cardiopulmonary resuscitation. We also compared the incidence of BCIS between those patients with and without possible risk factors, including intraoperative blood loss, arthroplasty, use of an intramedullary device, patient age, gender, tumor location, and preexisting lung cancer or lung metastasis. Results A total of 88 patients were included. BCIS occurred in 23 patients, with an incidence of 26.1%. Among them, 19 had grade I and 4 had grade II BCIS. There was no patients with grade III BCIS. The lowest blood pressure occurred within 10 min in 21 (87.5%) patients and within 20 min for all patients. A total of 9 grade I BCIS were self‐limiting. The other 10 grade I hypotension cases and all grade II hypotension cases recovered after administration of a vasoconstrictor medication. Preexisting lung cancer or lung metastasis was the risk factor for BCIS; 40.0% of patients (16 in 40 patients) with preexisting lung cancer or metastasis had BCIS, whereas only 14.6% of patients (7 in 48 patients) without lung lesions had BCIS. There was no risk difference in terms of arthroplasty, old age, and increased blood loss. Apart from grades I and II bone cement implantation syndrome, there were no other major complications, including death, cardiovascular events, or cerebrovascular events. Conclusion Bone cement implantation syndrome is not unusual in bone tumor surgeries, and preexisting lung cancer or lung metastasis is a risk factor.
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Affiliation(s)
- Tsung-Han Yang
- Department of Orthopaedic Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Rong-Sen Yang
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Hao Tseng
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Richardson CG, Lethbridge LN, Dunbar MJ. Increased Mortality with the Use of Cementless Fixation for Femoral Neck Fractures: Analysis of 5883 Hip Arthroplasty Cases. J Arthroplasty 2020; 35:3627-3630. [PMID: 32753265 DOI: 10.1016/j.arth.2020.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of cemented fixation for hip arthroplasty for femoral neck fractures has been advocated to limit the postoperative and intraoperative risk of periprosthetic fractures. However, there are concerns with the potential effects of cementing on patient mortality, particularly at the time of cementation. METHODS This study examined the mortality rates of cemented compared to cementless hip arthroplasty fixation in a group of 5883 femoral neck fracture patients from 2001 to 2017. The data were derived from large administrative databases and census data. Confounders were identified and controlled with a multivariate analysis. The data were also stratified into 2 time frames, 2001-2008 and 2009-2017, to determine if there was an effect of more recent improvements in patient care or implant technology. RESULTS Cemented fixation had a statistically significant reduction in mortality rates at 30, 90, and 365 days after surgery. There was no difference in mortality in 0, 1, or ≤7 days after discharge or during the admission. The mortality rate decreased but was still significantly increased with cementless fixation when the subjects were grouped from 2001 to 2008 and 2009 to 2017. CONCLUSION Based on this evidence, the cemented fixation of hip arthroplasty should be considered for patients with femoral neck fractures.
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Affiliation(s)
| | | | - Michael J Dunbar
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
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20
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Predictors of Medical Serious Adverse Events in Hip Fracture Patients Treated With Arthroplasty. J Orthop Trauma 2020; 34 Suppl 3:S42-S48. [PMID: 33027165 DOI: 10.1097/bot.0000000000001935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM Patients with hip fractures are often frail with multiple comorbidities and at risk of medical serious adverse events (SAEs). We investigated the HEALTH trial patient population to ascertain predictors of SAEs. METHODS We performed a multivariable Cox regression analysis. Occurrence of SAEs was included as the dependent variable with 31 potential prognostic factors being included as independent variables. RESULTS One thousand four hundred forty-one patients were included in this analysis. Three hundred seventy (25.6%) patients suffered from an SAE. The most common events were cardiac (38.4%, n = 105), respiratory (20.8%, n = 77), and neurological (14.1%, n = 77). The majority of SAEs (50.8%, n = 188) occurred in the first 90 days after hip fracture with 35.4% occurring in the first 30 days (n = 131). Body mass index (BMI) between 18.5 and 24.9 compared with BMI between 25 and 29.9 [hazard ratio (HR) 1.32, P = 0.03] and receiving a total hip arthroplasty compared with a bipolar hemiarthroplasty (HR 1.36, P = 0.03) were associated with a higher risk of a medical SAE within 24 months of femoral neck fracture. Age (P = 0.09), use of femoral cement (P = 0.59), and use of canal pressurization (P = 0.37) were not associated with a medical SAE. CONCLUSION Total hip arthroplasty is associated with more SAEs in the immediate postoperative period, and care should be taken in selecting patients for this treatment compared with a hemiarthroplasty. A higher BMI may be protective in hip fracture patients while age alone does not predict SAEs and neither does the use of femoral cement and/or pressurization. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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21
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Higher rate of complications with uncemented compared to cemented total hip arthroplasty for displaced intracapsular hip fractures: A randomised controlled trial of 50 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:587-594. [PMID: 33068165 PMCID: PMC7981295 DOI: 10.1007/s00590-020-02808-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/03/2020] [Indexed: 12/25/2022]
Abstract
Background The primary aim of this study was to compare the functional outcome of uncemented with cemented total hip arthroplasty (THA) for displaced intracapsular hip fractures. The secondary aims were to assess length of surgery, blood loss, complications and revision rate between the two groups. Methods A prospective double-blind randomised control trial was conducted. Fifty patients with an intracapsular hip fracture meeting the inclusion criteria were randomised to either an uncemented (n = 25) or cemented (n = 25) THA. There were no differences (p > 0.45) in age, gender, health status or preinjury hip function between the groups. The Oxford hip score (OHS), Harris Hip score (HHS), EuroQol 5-dimensional (EQ5D), timed get up-and-go (TUG), pain and patient satisfaction were used to assess outcome. These were assessed at 4, 12 and 72 months after surgery, apart from the TUG which as only assessed as 6 months. Results The study was terminated early due to the significantly (n = 8, p = 0.004) higher rate of intraoperative complications in the uncemented group: three fractures of the proximal femur and five conversions to a cemented acetabular component. There were no significant (p ≥ 0.09) differences in the functional measures (OHS, HSS, EQ5D, TUG and pain) or patient satisfaction between the groups. There was no difference in operative time (p = 0.75) or blood loss (p = 0.66) between the groups. There were two early revisions prior to 3 months post-operatively in the uncemented group and none in the cemented group, but this was not significant (log rank p = 0.16). Conclusion There was a high rate of intraoperative complications, which may be due to poor bone quality in this patient group. There were no ergonomic or functional advantages demonstrated between uncemented and cemented THA. Cemented THA should remain as the preferred choice for the treatment of intracapsular hip fractures for patients that meet the criteria for this procedure.
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"Cement Disease" in hip fracture patients - fact or fiction? Injury 2020; 51:2097-2098. [PMID: 32684308 DOI: 10.1016/j.injury.2020.07.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 02/02/2023]
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Duijnisveld BJ, Koenraadt KLM, van Steenbergen LN, Bolder SBT. Mortality and revision rate of cemented and uncemented hemiarthroplasty after hip fracture: an analysis of the Dutch Arthroplasty Register (LROI). Acta Orthop 2020; 91:408-413. [PMID: 32285730 PMCID: PMC8023919 DOI: 10.1080/17453674.2020.1752522] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Femoral neck fractures are commonly treated with cemented or uncemented hemiarthroplasties (HA). We evaluated differences in mortality and revision rates in this fragile patient group.Patients and methods - From January 1, 2007 until December 31, 2016, 22,356 HA procedures from the Dutch Arthroplasty Register (LROI) were included. For each HA, follow-up until death, revision, or end of follow-up (December 31, 2016) was determined. The crude revision rate was determined by competing risk analysis. Multivariable Cox regression analyses were performed to evaluate the effect of fixation method (cemented vs. uncemented) on death or revision. Age, sex, BMI, Orthopaedic Data Evaluation Panel (ODEP) rating, ASA grade, surgical approach, and previous surgery were included as potential confounders.Results - 1-year mortality rates did not differ between cemented and uncemented HA. 9-year mortality rates were 53% (95% CI 52-54) in cemented HA compared to 56% (CI 54-58) in uncemented HA. Multivariable Cox regression analysis showed similar mortality between cemented and uncemented HA (HR 1.0, CI 0.96-1.1). A statistically significantly lower 9-year revision rate of 3.1% (CI 2.7-3.6) in cemented HA compared with 5.1% (CI 4.2-6.2) in the uncemented HA was found with a lower hazard ratio for revision in cemented compared with uncemented HA (HR 0.56, CI 0.47-0.67).Interpretation - Long-term mortality rates did not differ between patients with a cemented or uncemented HA after an acute femoral neck fracture. Revision rates were lower in cemented compared with uncemented HA.
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Affiliation(s)
| | - Koen L M Koenraadt
- Foundation for Orthopaedic Research, Care and Education, Amphia Hospital, Breda
| | - Liza N van Steenbergen
- Dutch Arthroplasty Register, Landelijke Registratie Orthopedische Implantaten (LROI), ‘s Hertogenbosch
| | - Stefan B T Bolder
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
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Dogger MN, Fransen BL, Sierevelt IN, Nolte PA. Implant survival in uncemented total hip arthroplasty for displaced intracapsular femoral neck fractures: outcomes of 115 patients in a single center. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:885-893. [PMID: 32146516 DOI: 10.1007/s00590-020-02652-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/03/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION There remains disagreement about the use of cemented or uncemented total hip arthroplasty (THA) for patients with a displaced intracapsular femoral neck fracture (FNF). The aim of this study was to assess implant survival, mortality, and postoperative complication rates of uncemented THA for a displaced intracapsular FNF in a single center. PATIENTS AND METHODS A cohort of 115 patients who received uncemented THAs for a displaced intracapsular FNF was retrospectively examined for implant survival in terms of revision and any reoperation, mortality, and postoperative complications. RESULTS The one- and five-year implant survival was 99.1% (95% confidence interval (CI) 97.3-100.9) and 97.8% (95% CI 94.7-100.9) for revision and 93.6% (95% CI 88.9-98.3) and 90.0% (95% CI 83.3-96.7) for any reoperation, respectively. Impaired mobility was significantly associated with lower implant survival (p = 0.01). The one, three, and 12 month mortality rates were 2.8% (95% CI 0-5.9), 3.7% (95% CI 0.2-7.2), and 5.6% (95% CI 1.3-9.9), respectively. Postoperative complication rate was 10% with 5% intra-operative fractures. CONCLUSIONS Contrary to earlier reports of results of uncemented THA for displaced FNF, the results of this study were comparable with those reported in the literature for cemented THA in displaced FNF with respect to implant survival, mortality, and complication rates. This indicates that uncemented THA could be a viable option for these patients. In future, the additional literature with a prospective design is needed to support and reinforce our conclusion.
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Affiliation(s)
- Melissa N Dogger
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands.
| | - Bas L Fransen
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
- Department of Orthopaedic Surgery, CORAL - Center for Orthopaedic Research Alkmaar, Noordwest Ziekenhuisgroep Alkmaar, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
| | - Peter A Nolte
- Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Spaarnepoort 1, 2134 TM, Hoofddorp, The Netherlands
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Abstract
There is continued debate as to whether cemented or cementless implants should be utilized in particular cases based upon chronological age. This debate has been rekindled in the UK and other countries by directives mandating certain forms of acetabular and femoral component fixation based exclusively on the chronological age of the patient. This editorial focuses on the literature-based arguments to support the use of cementless total hip arthroplasty (THA), while addressing potential concerns surrounding safety and cost-effectiveness. Cite this article: Bone Joint Res. 2019;8(12):604-607.
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Affiliation(s)
- Sujith Konan
- University College Hospital and The Princess Grace Hospital, London, UK
| | - Matthew P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Fares S Haddad
- University College London Hospitals NHS Foundation Trust, The Princess Grace Hospital, and the NIHR Biomedical Research Centre at UCL H, London, UK
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Dale H, Børsheim S, Kristensen TB, Fenstad AM, Gjertsen JE, Hallan G, Lie SA, Furnes O. Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the -Norwegian Arthroplasty Register. Acta Orthop 2019; 91:152-158. [PMID: 31833434 PMCID: PMC7155214 DOI: 10.1080/17453674.2019.1701312] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - There are reports on perioperative deaths in cemented total hip arthroplasty (THA), and THA revisions are associated with increased mortality. We compared perioperative (intraoperatively or within 3 days of surgery), short-term and long-term mortality after all-cemented, all-uncemented, reverse hybrid (cemented cup and uncemented stem), and hybrid (uncemented cup and cemented stem) THAs.Patients and methods - We studied THA patients in the Norwegian Arthroplasty Register from 2005 to 2018, and performed Kaplan-Meier and Cox survival analyses with time of death as end-point. Mortality was calculated for all patients, and in 3 defined risk groups: high-risk patients (age ≥ 75 years and ASA > 2), intermediate-risk patients (age ≥ 75 years or ASA > 2), low-risk patients (age < 75 years and ASA ≤ 2). We also calculated mortality in patients with THA due to a hip fracture, and in patients with commonly used, contemporary, well-documented THAs. Adjustement was made for age, sex, ASA class, indication, and year of surgery.Results - Among the 79,557 included primary THA patients, 11,693 (15%) died after 5.8 (0-14) years' follow-up. Perioperative deaths were rare (30/105) and found in all fixation groups. Perioperative mortality after THA was 4/105 in low-risk patients, 34/105 in intermediate-risk patients, and 190/105 in high-risk patients. High-risk patients had 9 (CI 1.3-58) times adjusted risk of perioperative death compared with low-risk patients. All 4 modes of fixation had similar adjusted 3-day, 30-day, 90-day, 3-30 day, 30-90 day, 90-day-10-year, and 10-year mortality risk.Interpretation - Perioperative, short-term, and long-term mortality after primary THA were similar, regardless of fixation type. Perioperative deaths were rare and associated with age and comorbidity, and not type of fixation.
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Affiliation(s)
- Håvard Dale
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department Clinical Medicine, University of Bergen, Bergen; ,Correspondence:
| | | | - Torbjørn Berge Kristensen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department Clinical Medicine, University of Bergen, Bergen;
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department Clinical Medicine, University of Bergen, Bergen;
| | - Stein Atle Lie
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department Clinical Medicine, University of Bergen, Bergen;
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Schwarzkopf E, Sachdev R, Flynn J, Boddapati V, Padilla RE, Prince DE. Occurrence, risk factors, and outcomes of bone cement implantation syndrome after hemi and total hip arthroplasty in cancer patients. J Surg Oncol 2019; 120:1008-1015. [PMID: 31432531 DOI: 10.1002/jso.25675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 08/05/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients undergoing cement fixation for hip arthroplasty are at increased risk of developing bone cement implantation syndrome (BCIS). We sought to determine: what is the occurrence of BCIS in patients with cancer after hip arthroplasty? What are the risk factors in patients with cancer for the development of this syndrome? What is the outcome for patients with cancer having BCIS? METHODS We identified 374 patients with cancer who underwent cemented hip arthroplasty between 2010 and 2014. Patient characteristics, operative variables, and outcomes were collected. RESULTS BCIS occurred in 279 (75%) patients. A total of 353 (94%) patients had bone metastases and 179 (48%) patients had lung metastases at the time of surgery. Age greater than 60 (hazard ratio [HR] 2.09, P = .02) and the presence of lung metastases (HR 1.77, P = .019) were associated with increased risk of BCIS. Increased perioperative use of vasopressors (HR 1.72, P = .023) and increased hospital stay beyond 10 days (HR 2.67, P = .003) was associated with BCIS. CONCLUSIONS BCIS is a frequent clinical event in patients with cancer undergoing femoral cemented arthroplasty with increased risk for patients over age 60 and those with compromised lung function due to lung metastases and lung cancer. Patients who develop BCIS are more likely to require longer postoperative hospitalization. Careful preoperative assessment and intraoperative communication are crucial steps to reduce the consequences of BCIS.
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Affiliation(s)
| | | | - Jessica Flynn
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Venkat Boddapati
- New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Roger E Padilla
- Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel E Prince
- Orthopaedic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Guest Editorial: An Appeal for Evidenced-based Care and Adoption of Best Practices in the Management of Displaced Femoral Neck Fractures. Clin Orthop Relat Res 2019; 477:913-916. [PMID: 30801284 PMCID: PMC6494326 DOI: 10.1097/corr.0000000000000639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Hines CB, Collins-Yoder A. Bone Cement Implantation Syndrome: Key Concepts for Perioperative Nurses. AORN J 2019; 109:202-216. [PMID: 30694541 DOI: 10.1002/aorn.12584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bone cement implantation syndrome (BCIS) is a potentially fatal complication of orthopedic surgeries that use cement. The symptoms of BCIS occur primarily during femoral fracture repairs, but this complication has been reported in a wide variety of cemented procedures. Clinical presentation of this syndrome begins as a cascade with hypoxia and hypotension; if it is not reversed, it ends with right-sided heart failure and cardiac arrest. This syndrome usually occurs at cementation, prosthesis insertion, joint reduction, or tourniquet deflation, and should be treated with aggressive resuscitation and supportive care. This article provides a comprehensive explanation of bone cement, the identification and management of BCIS, and the roles of the perioperative team in the event of cardiopulmonary collapse. It includes a case study that can be used as an educational tool for simulation, mock drills, or staff meetings; it also may be used as a framework for creating policies.
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Izumi Y, Ishihara S, Cammack I, Miyawaki I. Massive mass embolism detected by transesophageal echocardiography in bone cement implantation syndrome: a case report. JA Clin Rep 2019; 5:5. [PMID: 32026061 PMCID: PMC6967219 DOI: 10.1186/s40981-019-0225-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/16/2019] [Indexed: 12/02/2022] Open
Abstract
Bone cement implantation syndrome (BCIS) is a known complication in patients undergoing cemented orthopedic surgeries; however, the etiology and pathophysiology of BCIS are not fully understood. We report the case of a patient who developed pulseless electrical activity (PEA) due to BCIS after cemented femoral head replacement. Transesophageal echocardiography (TEE) during PEA revealed a massive embolus extending from the main pulmonary artery to the inferior vena cava. Of note, this embolus disappeared completely and rapidly after return of spontaneous circulation. TEE proved to be useful in the diagnosis and management of this case of PEA.
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Affiliation(s)
- Yuki Izumi
- Department of Anesthesiology and Critical Care, Teine Keijinkai Hospital, 006-0085 12-1-40, 1-jo, Maeda, Teine-ku, Sapporo, Hokkaido, Japan.
| | - Satoshi Ishihara
- Department of Anesthesiology and Critical Care, Teine Keijinkai Hospital, 006-0085 12-1-40, 1-jo, Maeda, Teine-ku, Sapporo, Hokkaido, Japan
| | - Ivor Cammack
- Department of Clinical Residency, Teine Keijinkai Hospital, 006-0085, 12-1-40, 1-jo, Maeda, Teine-ku, Sapporo, Hokkaido, Japan
| | - Ikuko Miyawaki
- Department of Anesthesiology and Critical Care, Kobe City Medical Center General Hospital, 650-0047, 2-1-1, Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, Japan
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Yung-Chak HA. Changes in Rehabilitation Outcomes by new Guidelines of Hong Kong Hospital Authority in Implant Choice for Femoral Neck Fractures—Austin Moore versus Cemented Exeter Hemiarthroplasty. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2018. [DOI: 10.1016/j.jotr.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background In 2013, Hospital Authority of Hong Kong replaced Austin Moore Arthroplasty (AMA) with cemented Exeter hemiarthroplasty for displaced femoral neck fractures. This study evaluated whether this new guidelines resulted in better mortality, hospital service reattendances and rehabilitation outcomes. Methods Patients aged 65–84 years with hemiarthroplasty done in a tertiary hospital during 2012–2014 were reviewed retrospectively. AMA group included AMAs carried out during years 2012–2013, and Exeter group included cemented modular Exeter hemiarthroplasties carried out during years 2013–2014. All patients were followed-up for 2 years. Results The Exeter group performed significantly better in rehabilitation outcomes than AMA group in terms of mobility score, independent and outdoor walking and community dwelling. They also had less hospital service reattendances due to falls, refractures and implant-related causes. There was a trend towards lower mortality in the Exeter group with increasing duration from operation. Conclusion The new guidelines in replacing AMA with cemented Exeter hemiarthroplasty resulted in better patient outcomes.
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Affiliation(s)
- Hsu Albert Yung-Chak
- Department of Orthopaedics and Traumatology, United Christian Hospital, Kowloon, Hong Kong
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Chen KK, Nayyar S, Davidovitch RI, Vigdorchik JM, Iorio R, Macaulay W. Cemented Compared with Uncemented Femoral Fixation in the Arthroplasty Treatment of Displaced Femoral Neck Fractures. JBJS Rev 2018; 6:e6. [DOI: 10.2106/jbjs.rvw.17.00119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Yardley IE, Carson-Stevens A, Donaldson LJ. Serious incidents after death: content analysis of incidents reported to a national database. J R Soc Med 2018; 111:57-64. [PMID: 29169009 PMCID: PMC5814035 DOI: 10.1177/0141076817744561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022] Open
Abstract
Objectives To describe serious incidents occurring in the management of patient remains after their death. Design Incidents occurring after patient deaths were analysed using content analysis to determine what happened, why it happened and the outcome. Setting The Strategic Executive Information System database of serious incidents requiring investigation occurring in the National Health Service in England. Participants All cases describing an incident that occurred following death, regardless of the age of the patient. Main outcome measures The nature of the incident, the underlying cause or causes of the incident and the outcome of the incident. Results One hundred and thirty-two incidents were analysed; these related to the storage, management or disposal of deceased patient remains. Fifty-four incidents concerned problems with the storage of bodies or body parts. Forty-three incidents concerned problems with the management of bodies, including 25 errors in postmortem examination, or postmortems on the wrong body. Thirty-one incidents related to the disposal of bodies, 25 bodies were released from the mortuary to undertakers in error; of these, nine were buried or cremated by the wrong family. The reported underlying causes were similar to those known to be associated with safety incidents occurring before death and included weaknesses in or failures to follow protocol and procedure, poor communication and informal working practices. Conclusions Serious incidents in the management of deceased patient remains have significant implications for families, hospitals and the health service more broadly. Safe mortuary care may be improved by applying lessons learned from existing patient safety work.
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Affiliation(s)
- Iain E Yardley
- Department of Paediatric Surgery, Evelina London Children’s Hospital, London SE1 7EH, UK
- Kings College London, London WC2R 2LS, UK
| | - Andrew Carson-Stevens
- Wales Centre for Primary and Emergency Care Research, Cardiff University, Cardiff CF10 3AT, UK
- Australian Institute of Health Innovation, Macquarie University, Sydney NSW 2109, Australia
- Department of Family Practice, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Liam J Donaldson
- Department of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Nawaz SZ, Keightley AJ, Desai A, Granville-Chapman J, Elliott D, Newman K, Khaleel A. Displaced intracapsular neck of femur fractures: Outcome of 810 hydroxyapetite coated (HAC) uncemented hemiarthroplasties. Injury 2017; 48:909-913. [PMID: 28259379 DOI: 10.1016/j.injury.2016.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/16/2016] [Indexed: 02/02/2023]
Abstract
A Cochrane review influenced new NICE guidelines, which recommended surgeons: Offer cemented implants to patients undergoing surgery with arthroplasty. However our trust routinely uses HAC uncemented stem (Taperloc®, Biomet) hemiarthroplasties. A review of a consecutive series of uncemented HAC stem hemiarthroplasties including measures such as intro-operative complications, mortality and revision surgery. Prospectively collected data between January 2008 and June 2014 was used, with medical record and radiographic reviews performed. 810 consecutive Taperloc uncemented hemiarthroplasty with monopolar heads were performed in 763 patients, with a minimum 12 month follow-up (12-90) follow-up. Mean age 83yrs; 71% female. Meantime to operation was 28.5h. 30day mortality: 4.4% (33/763). One year mortality was 11.2% (89/763). 2.5% (20/810) were admitted on a separate admission with the periprosthetic fracture. 0.6% (5/810) were revised to total hip replacement for subsidence and associated pain. Only 1% (8/810) had intraoperative calcar fractures, all of which were treated with intraoperative cabling with no evidence of clinically relevant subsidence or medium term complications requiring revision surgery within a year. To the author's knowledge this is largest outcome series for modern design uncemented hemiarthroplasty. Our study shows comparable data to cemented hemiarthroplasty but no deaths in the first 2days post-op. Our series also demonstrates a well below average mortality figures which are clearly multifactorial but believe uncemented prosthesis play a role. We believe that uncemented proven stem design hemiarthroplasty remains a safe and good surgical option for displaced intracapsular fractures.
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Affiliation(s)
- S Z Nawaz
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia.
| | - A J Keightley
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - A Desai
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - J Granville-Chapman
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - D Elliott
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - K Newman
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
| | - A Khaleel
- Rowley Bristow Orthopaedic Unit, Ashford and St Peters NHS Foundation Trust, Australia
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Rezaie W, Wei W, Cleffken BI, van der Vlies CH, Cleffken BI, Roukema GR. Internal Fixation Versus Hemiarthroplasty for Displaced Intra-Capsular Femoral Neck Fractures in ASA 3-5 Geriatric Patients. Open Orthop J 2016; 10:765-771. [PMID: 28217201 PMCID: PMC5299552 DOI: 10.2174/1874325001610010765] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The treatment of choice for elderly with a displaced intra-capsular femoral neck fractures is prosthetic replacement. This is however a major surgical procedure for geriatric patients with multiple co-morbidities which can threaten hemodynamic stability and lead to death. In this study we compared the outcome of internal fixation (IF) versus hemiarthroplasty (HA) for the management of intra-capsular femoral neck fractures in the elderly with severe co-morbidities. METHODS We conducted a retrospective cohort study of all the patients who were admitted to our Level-II trauma centre with a femoral neck fracture between January 2009 and June 2011. Inclusion criteria were: 70 years or older, ASA 3 or higher, a displaced femoral neck fracture and treatment with either internal fixation or a cemented hemiprosthesis. The primary outcome was 6-month mortality rate. Secondary outcomes were 30-day mortality, post-operative complications, re-operation rate and length of hospital stay. RESULTS 80 patients met our inclusion criteria. The mean age of the IF group was 81.6 years and in the HA group it was 84.5 years (P=0.07). The medical records were retrieved 34-64 months after surgery. Two intra-operative deaths due to cement implantation syndrome were found in the HA group and none in the IF group. Twelve patients (21.8%) in the HA group died within 30 days after surgery and 2 (8.0%) in the IF group (P=0.21). The mean operating time was 83 min. for the HA group and 51 min. for the IF group (P=0.000). There were more implant-related complications in the IF than in the HA group (36% vs 9.1% respectively, P=0.008). The 6-month mortality rates didn't differ between the IF and the HA groups (respectively 28.0% vs 34.5%, P=0.62). CONCLUSION The post-operative mortality rates did not differ between the IF and the HA groups in elderly patients with a displaced femoral neck fracture and ASA 3 to 5. However, the HA associated with less implant-related complications than the IF in this group and it is therefore the treatment of choice.
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Affiliation(s)
- W Rezaie
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - W Wei
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - B I Cleffken
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - C H van der Vlies
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - B I Cleffken
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - G R Roukema
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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Saleh KJ, El Othmani MM, Tzeng TH, Mihalko WM, Chambers MC, Grupp TM. Acrylic bone cement in total joint arthroplasty: A review. J Orthop Res 2016; 34:737-44. [PMID: 26852143 DOI: 10.1002/jor.23184] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 02/03/2016] [Indexed: 02/04/2023]
Abstract
Acrylic bone cement has a variety of applications in orthopedic surgery. Primary uses in total arthroplasties are limited to prostheses fixation and antibiotic delivery. With the large number of total joint arthroplasties expected to continue to rise, understanding the role bone cement plays in the success of total joint arthroplasty can have a significant impact on daily practice. The literature is inconclusive on whether cemented or cementless fixation technique is superior, and choice of fixation type is mainly determined by surgeon preference and experience. Surgeons should understand that if poor techniques exist, short-term outcomes of the replaced joint may be at risk. Statement of clinical significance: This article attempts to clarify some points of bone cement use through a review of the mechanical properties related to bone cement, a comparison to alternative materials, influence of additives, and the effects on surgical outcomes. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:737-744, 2016.
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Affiliation(s)
- Khaled J Saleh
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - Mouhanad M El Othmani
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - Tony H Tzeng
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - William M Mihalko
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, 956 Court Ave, Suite E226, Memphis, Tennessee, 38163
| | - Monique C Chambers
- Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, 62794-9679
| | - Thomas M Grupp
- Clinic for Orthopaedic Surgery, Campus Grosshadern, Ludwig Maximilians University, Munich, Germany Aesculap AG, Research & Development, Tuttlingen, Germany
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Gregersen M, Krogshede A, Brink O, Damsgaard EM. Prediction of Reoperation of Femoral Neck Fractures Treated With Cannulated Screws in Elderly Patients. Geriatr Orthop Surg Rehabil 2015; 6:322-7. [PMID: 26623169 PMCID: PMC4647203 DOI: 10.1177/2151458515614369] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Reoperation of femoral neck fractures in elderly patients is frequent. Our aim was to determine predictors of reoperations following primary internal fixation with 3 cannulated screws. MATERIALS AND METHODS A follow-up study included all patients aged 65+ years old patients consecutively admitted to an orthopedic ward with femoral neck fracture in the period from January 1, 2007, to December 31, 2010, and fixed with cannulated screws. We retrospectively obtained all available data from patient databases related to potential predictors of reoperations: gender, age, dwelling, dementia, body mass index, vitamin D, albumin, prednisolone treatment, walking aid, performance of activities of daily living, low-energy trauma, initial displacement, and surgery quality. Outcome was reoperation due to fixation failure/prominent screws, nonunion, or avascular necrosis of femoral head within 2 years after surgery. By multivariate Cox proportional hazards regression, including mortality as a competing risk, we estimated crude and adjusted hazards ratios (HRs) with 95% confidence intervals (CIs) for reoperation. RESULTS Two years after surgery, 29% of 322 elderly patients underwent reoperation. Reoperation was associated with primary fracture displacement (HRadjusted 1.61; 95% CI: 1.01-2.55; P = .04) compared to undisplacement. A poor quality of primary reduction was associated with a higher risk of reoperations than a good quality (HRadjusted 1.95; 95% CI: 1.02-3.72; P = .04). Elderly individuals in own homes and sheltered housings had a higher risk of reoperation (HRadjusted 2.67; 95% CI 1.35-5.31; P = .005) compared to nursing home residents. CONCLUSION Our findings support the evidence of a higher incidence of reoperation in displaced femoral neck fractures compared to the nondisplaced and is associated with poor quality of fracture reduction. Reoperations are most frequent in younger and more independent patients living at home.
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Affiliation(s)
- Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Anna Krogshede
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Brink
- Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark
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Abstract
INTRODUCTION Hip fracture poses a significant global challenge both to healthcare systems and to patients themselves. We outline the management of this injury, highlight areas where the evidence is deficient and discuss research efforts towards improving the quality of the evidence base. SOURCES OF DATA We searched MEDLINE, PubMed and the Cochrane Library, using the core search terms 'hip fracture' and 'proximal femoral fracture'. In addition we reviewed national treatment guidelines for hip fracture care and references from relevant articles. Only articles published in English from inception to March 2015 were included. AREAS OF AGREEMENT Modern hip fracture management should consist of a coordinated multidisciplinary approach with orthogeriatrician input, early surgery, adequate analgesia and liaison with related services to facilitate safe supported discharge. AREAS OF CONTROVERSY The optimum thromboprophylaxis to reduce venous thromboembolism remains a topic for debate. The use of bone cement has received much attention recently with concerns about its safety in the frailest of hip fracture patients. GROWING POINTS An increasing understanding of the severity and impact of sustaining a hip fracture upon quality of life. AREAS TIMELY FOR DEVELOPING RESEARCH Strategies to improve postoperative mobility, postoperative nutrition and the role of home-based rehabilitation. There is a need to identify the optimum analgesic regimes and assessment tools for hip fracture patients with cognitive impairment.
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Affiliation(s)
- M A Fernandez
- University Hospitals Coventry & Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - X L Griffin
- Clinical Trials Unit, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - M L Costa
- University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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39
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Implant-related complications following hip hemiarthroplasty: a comparison of modern cemented and uncemented prostheses. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:1161-4. [PMID: 26174416 DOI: 10.1007/s00590-015-1671-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/04/2015] [Indexed: 10/23/2022]
Abstract
Fractured neck of femurs is a very common presentation to hospital, especially in an elderly population and in almost all cases requires an operation, usually a cemented or uncemented hemiarthroplasty. Current evidence and multiple guidance issued in UK suggest the use of cemented hemiarthroplasty above uncemented prostheses. This retrospective case series performed in District General Hospital in Wales, UK. Notes and radiographs of 80 consecutive patients who had hemiarthroplasty for the fracture of neck of femur were examined by independent observer. All patients received modern prosthesis-collarless, polished tapered cemented stem or fully HA-coated uncemented stem-based on the choice of treating consultant. There were 47 uncemented prostheses and 33 cemented hemiarthroplasties used. We identified 12 significant complications in the uncemented group (26 %) as compared to three in the cemented group (6 %). The most significant difference was periprosthetic fracture rate, with five in the uncemented group (10.7 %) as compared to none in the cemented group. There were a total of six reoperations in four patients all of whom had initially undergone uncemented operations. In both groups, 24-h mortality rate was similar. Our study supports the use of modern cemented prosthesis as opposed to modern uncemented hemiarthroplasty. Post-operative complication rate after uncemented prosthesis is unacceptably high, especially periprosthetic fracture rate.
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40
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Affiliation(s)
| | - J Waddell
- St. Michael's Hospital, 55 Queen Street, East, Suite #207, Toronto, Ontario, Canada
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41
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Schaller G, Black J, Asaad A, Harper N, Webb S, Muirhead-Allwood S. Primary collared uncemented total hip arthroplasties in the elderly: a safe and reliable treatment option. J Arthroplasty 2015; 30:407-10. [PMID: 25456637 DOI: 10.1016/j.arth.2014.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/25/2014] [Accepted: 10/05/2014] [Indexed: 02/07/2023] Open
Abstract
The age of patients undergoing primary Total Hip Arthroplasty (THA) remains fairly constant despite an increasingly elderly population, possibly owing to concern over postoperative complications. This study evaluated 90-day outcomes in patients over 80, undergoing uncemented collared primary THA for osteoarthritis in a high volume unit. Data were recorded from 153 consecutive patients. There were 0.65% mortality rate and 1.3% major systemic complication rate. American Society of Anesthesiologist (ASA) grade was an independent predictor of inpatient complications. Mean preoperative and 90-day postoperative Oxford Hip Score was 24 and 46 respectively. No radiological evidence of femoral stem migration was seen. Our cohort shows low morbidity and mortality rates. ASA not age helps predict inpatient complications. Uncemented collared femoral prosthesis resulted in excellent functional and radiological outcomes.
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Affiliation(s)
| | | | | | | | - Stuart Webb
- King Edward VII's Hospital Sister Agnes, London, England
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